Summary
Definition
History and exam
Key diagnostic factors
- occupational exposure to sensitizing agents or irritants
- symptoms of asthma that improve during holidays
- initial onset of asthma symptoms during a work period
Risk factors
- high-level exposure to sensitizer
- atopy
- genetic factors
- smoking
Diagnostic investigations
1st investigations to order
- spirometry (pre- and post-bronchodilator)
- chest x-ray
- skin prick testing
- specific serum IgE assay
- nonspecific bronchial provocation testing
- serial peak expiratory flow rate
Investigations to consider
- specific inhalation challenge
Emerging tests
- induced sputum cytology
- exhaled nitric oxide
Treatment algorithm
sensitizer-induced
irritant-induced
symptomatic asthma
Contributors
Authors
Ryan Hoy, MB BS, MOEH, FRACP

Respiratory Physician
The Alfred Hospital
Melbourne
Victoria
Australia
Disclosures
RH declares that he has no competing interests.
Susan M. Tarlo, MB BS FRCP(C)

Professor of Medicine
University of Toronto
Respiratory Physician
Toronto Western Hospital
Toronto
Ontario
Canada
Disclosures
SMT declares that she has no competing interests.
Peer reviewers
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Disclosures
WK declares that he has no competing interests.
Karin Pacheco, MD
Associate Professor of Medicine
National Jewish Medical Centre
Denver
CO
Disclosures
KP declares that she has no competing interests.
Philip Harber, MD
Professor of Medicine
University of California
Los Angeles
CA
Disclosures
PH declares that he has no competing interests.
Differentials
- Work-exacerbated asthma
- Occupational eosinophilic bronchitis
- Coincidental nonoccupational asthma
More DifferentialsGuidelines
- Global strategy for asthma management and prevention
- Japanese guidelines for occupational allergic diseases 2020
More GuidelinesPatient leaflets
Asthma in adults
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